With the decline in frequency and indication for invasive needle procedures, a realistic model is essential to obtain and maintain proficiency. We sought to design a realistic periumbilical blood sampling (PUBS) and intravascular transfusion (IVT) model and curriculum to teach proper technique to Maternal-Fetal Medicine fellows.
A human placenta (term or preterm) with attached umbilical cord was obtained. The umbilical arteries and vein were cannulated with an appropriate sized catheter, attached to the Model 700 Doppler Flow Controller/ Pumping System (Cole-Parmer Instrument Company, Vernon Hills, Illinois) and a separate infusion pump, respectively, creating two closed circuit vascular systems. ATS Doppler Test fluid (blood-mimicking fluid) was circulated through both systems. The placental unit was placed in an uncovered plastic container and submerged in water. A sonographic gel filled freezer bag was placed atop the fluid and container to simulate an abdominal-uterine wall. Under ultrasound guidance a needle was used to perform PUBS followed by IVT. The removal of fluid was confirmed and the infusion of fluid visualized sonographically as turbulent flow. Varying placental location within the unit allows for different levels of difficulty and experience.
Our periumbilical blood sampling and intravascular transfusion teaching model and curriculum was used to train Maternal-Fetal Medicine fellows in correct equipment set up, sonographic identification of umbilical vessels, procedural approach and proper technique for transfusion. Areas of procedural difficulties can be identified and practiced prior to the performance in clinical practice. Preprocedure practice can also be performed by placing the placenta in a position to mimic the actual orientation in a patient.
This is the first description of a placental model with functioning umbilical circulation to simulate PUBS and IVT procedures. Our model can be used to assist the Maternal-Fetal Medicine fellow with the skill and confidence needed to perform PUBS and IVT.
© 2009 Mosby, Inc. Published by Elsevier Inc. All rights reserved.